Lecture 18: Headaches Flashcards
What type of headache is the most common?
What gender are headaches most common in?
tension type headaches
females
What ocular disorders can you get a secondary headache from?
- acute glaucoma,
- refractive error
- heterophoria/tropia
- ocular inflammation
- Trauma
6.Vascular - Raised ICP
What types of primary headaches can you get?
Migraine
* Tension type headache
* Trigeminal autonomic cephalalgias (cluster headache)
* Other primary headache disorders
What are the 5 phases of a migraine?
- Premonitory symptoms - affects 60%
- Aura - affects 20%
- Headache - affects 80%
- Termination
- Postdrome
What are the premonitory symptoms you can get for migraines?
An awareness that an attack is going to happen
psychological symptoms:
* depression, euphoria, mental slowness, hyperactivity
neurologic phenomena
* photophobia, phonophobia
* nausea / vomiting
general
* coldness, loss of appetite, food cravings
What are the features of aura in a migraine?
Develops over 5 - 20 minutes
Normally lasts less than 60 minutes
- ‘Prolonged aura’ last up to a week
- The effects of a ‘migranous infarction will last longer
Focal neurological symptoms:
Sensory:
* visual, auditory, numbness, tingling
* Heightened sensitivity
Motor:
* ophthalmoplegia, hemiplegia
What is visual aura?
What are the signs?
Retinal migraine in which the symptoms are purely uniocular
Teichopsia
* Fortification spectra
- Hemianopia
- scintillating scotomata
- Water running down the windscreen
- Heat haze
- Broken up / cracked mirror
- “Tunnel vision”
- Very rarely total visual loss
When is the onset of the headache in migraines?
How long does it last?
What are the symptoms?
What is it associated with?
60 mins after aura finishes
4-72 hours
moderate to severe
pulsating
unilateral
aggravated by movement
photophobia or phonophobia
* poor concentration
* nausea, vomiting
What is typical aura like with a non-migraine headache?
What must you rule out?
visual,sensory, speech symptoms
Gradual development
* No longer than one hour
* Mix of positive and negative features
* Complete reversibility
* Absence of typical headache associated with migraine
transient ischaemic attack
What is the pathophysiology of a migraine?
What are the external triggers?
What are the visual triggers?
Thought to be vascular in origin
* vessel constriction corresponds to
aura
* vessel dilation corresponds to headache
* Pain from Intra-cranial, extra-cerebral vessels
- Physiological trigger unknown
- Genetic influence
- many have positive family history
- Tiredness, certain foods or drinks, bright lights
glare (sun reflections, windows)
Flicker (flashlights, stroboscopes, TV or cinema)
Patterns (text)
What is the management of migraines?
If obvious diagnosis, letter of information to GP
* Reassurance
* not life threatening
* not associated with serious illness
* exception can be young women on ‘the pill’
* no known cure
- Write a ‘headache diary’
- to identify and avoid triggers
- Medication
- pain relief during acute attack
- preventative if > 5 attacks per month
What are the types of tension headaches you can get?
What are the features and symptoms of a tension headache?
What is it associated with?
Episodic or chronic
* Last 30 mins to 7 days
- Bilateral
- Occipital, parietal or posterior neck
- Tightness/pressing/band-like (but not pulsating)
- Mild to moderate – does not stop daily activities
- Not made worse by routine physical activity
- May be associated with photophobia and phonophobia
- No nausea/vomiting
- Associated with sleeplessness, stress or emotional conflict
- Differential diagnosis with migraine difficult
What is the pathophysiology of a tension headache?
What is the management?
muscle contraction
associated with psychological problems
routine referral to GP
What is trigeminal autonomic cephalgias?
What are the signs?
Who does it effect more?
Pain on one side of the head in area of the trigeminal nerve
cluster headaches
1-8 attacks over a period of days or weeks
* may be associated with facial flushing, conjunctival injection, eyelid oedema, rhinorrhea, pupil constriction and partial ptosis
Starts around one eye or cheek
* Spreads across head
* Reaches a peak in a few minutes
* Lasts 30 minutes - a few hours
* Intense pain
* Sufferers bang head against wall
* Burn head with hot compresses
* Wakes patient in early hours
men x6 more than females
What is the pathophysiology of trigeminal autonomic cephalgias?
What is the management?
Cause unknown,
* no demonstrable pathology
*fMRI:
* Hypothalamic activity
refer to GP
prophylactic meds
analgesics
